Elective intubation and positive pressure ventilation for transbronchial lung biopsy

Abstract

Background: The safety of transbronchial lung biopsy (TBLB) on positive pressure mechanical ventilation has been controversial due to a presumed risk of pneumothorax. Data are especially limited on TBLB with elective intubation and mechanical ventilation. In this study, we compared complications of TBLB in patients who were electively mechanically ventilated for the procedure to those who were not.

Material and methods: A retrospective review of nonventilator-dependent patients who underwent TBLB in our institution from January 2010 to May 2016 was performed. The mechanical ventilation (MV) and nonmechanical ventilation (NMV) groups were compared with respect to patient demographics, numbers of lobes biopsied (single or multiple), preprocedure and postprocedure diagnoses, and complications. Complications were defined as pneumothorax of any size, major hemorrhage, prolonged intubation, and reintubation within 72 hours from TBLB.

Results: A total of 394 patients were identified. The MV group had 351 patients with mean age of 64.6 years, and the NMV group had 43 patients with mean age of 60.0 years. There were no significant differences with regards to age, gender, or number of lobes biopsied. There was no significant difference in the occurrence of pneumothorax (5.4% versus 4.7%, P = 1.00), hemorrhage (1.7% versus 4.7%, P = 0.21), and prolonged intubation or reintubation (3.1% versus 2.3%, P = 1.00) between the two groups.

Conclusions: When performing TBLB, there was no significant difference observed in the rate of complications between MV and NMV groups. Elective positive pressure mechanical ventilation for TBLB for nonventilator-dependent patients is safe and does not increase the risk of complications.

Keywords: Complication; Pneumothorax; Positive pressure ventilation; Transbronchial lung biopsy.